Elien Neimeijer

61 Limitations There are several limitations of this study that should be mentioned. First, data were collected in only one facility, which limits the generalizability of the findings. Second, it was not possible to derive causal relations between group climate, aggressive incidents, and coercive measures, because of the cross-sectional design. We expect, however, bi- directional relations between the aspects of group climate and the number of aggressive incidents on the living group. Further studies with a longitudinal design are needed to explore causality between group climate, aggressive incidents, and coercive measures. Third, the sample size did not allow us to include more variables in the multilevel struc- tural equation model. Also, regarding further analyses of different subgroups (e.g., differ- ences between the hypothesised relation among men and women), future studies on the association between group climate, aggressive behaviour and coercive measures should use a larger sample, representing multiple organisations. Further, future studies might explore how other personal and contextual characteristics, for example, diagnoses of clients, team functioning and organisational factors, interact with aggressive incidents and use of coercive measures. Implications The current study supports the importance of the relation between the frequency of aggressive incidents and social environmental factors, which underlines the transaction models underlying inpatient aggression in daily practices (see Jahoda, Willner, Pert, & MacMahon, 2013). It can be expected that interventions focused on this transactional model will show an impact on both the group climate and the prevalence of aggressive incidents. It is advised that ongoing training of sociotherapists is facilitated by organi- sations, focussing on providing support, creating possibilities for growth, and creating a safe atmosphere in which learning becomes possible for clients with MID-BIF. In an open and therapeutic group climate, the occurrence of aggressive incidents may de- crease and may contribute to better treatment results. Also, organisations should strive to minimize repression, as repression hinders the development of a therapeutic group climate, motivation for and susceptibility to treatment, and in the end rehabilitation (De Valk et al., submitted).